Definition |
Causes |
Risk Factors |
Symptoms |
Diagnosis |
Treatment |
Prevention
Definition
A sacral stress fracture is a small break in the sacrum. The sacrum is a large triangular bone. It is the base of the spine and connects to the pelvis.
Spondylolysis
fracture specifically affects the back thinner side of the bone.
Stress fractures are caused by repeated physical stress or conditions that make the bones weaker. Sacral stress fractures are most common in young athletes and older women with
osteoporosis. If you have unexplained lower back pain, talk to your doctor. Prompt treatment can prevent the injury from further problems.
Causes
Sacral stress fractures can be caused by repetitive stress or weakened bones. Factors that can contribute to this type of fracture include:
- Vigorous physical activities
- Repeated physical stress, especially involving back movements
- Conditions that affect bone density
Risk Factors
These factors increase your chance of sacral stress fractures. Tell your doctor if you have any of these risk factors:
- Long-distance runner
- Certain sports: gymnastics, football, track and field, and other high-impact sports
- Recent change in physical routine, particularly more intensive workout
- Weight-bearing activities: weight lifting, military training
- History of osteoporosis
- Diagnosis of low bone mineral density—low bone density indicates more bone loss than bone growth
- Radiation therapy
-
History of
Paget’s disease,
hyperparathyroidism, osteopenia, or
rheumatoid arthritis
- Female athlete who has missed periods
- Adolescents with incomplete bone growth
Symptoms
The most common symptom of a sacral stress fracture is low back pain. If you have any of these symptoms do not assume it is due to a sacral stress fracture. These symptoms may be caused by other conditions. Tell your doctor if you have any of these:
- Severe pain to lower back, hip, or pelvis
- Pain to buttocks or groin
- Increase in pain during your workout
- Lower back tenderness when touched
- Swelling at lower back
Diagnosis
Your doctor will ask about your symptoms and medical history. A physical exam will be done. Sometimes blood tests will be taken. You may be referred to a spine specialist or a surgeon who specializes in bone problems.
Tests may include the following:
- X-ray
of your lower back—test that uses radiation to take a picture; used to view any small cracks in the sacral bone
If the x-ray images are not definitive, you may have:
- CT scan
of your lower back—type of x-ray that uses a computer to create more detailed images
- MRI scan
of your lower back—a test that uses magnetic waves to show swelling and inflammation inside the bone
- Bone scan
—test that determines mineralization of bone
Treatment
In general, treatment depends on the cause and severity. These fractures are often treated with rest and medications for pain. Minimally invasive procedures are sometimes used. Surgery may be needed. In this case a pin may be inserted into the bone. This will strengthen it and allow it to heal. Treatment options include the following:
Your
plan will depend upon what caused the fracture. Fractures caused by physical
stress
need
rest.
Return to full activity and weight bearing is gradual.
Fractures due to
osteoporosis are treated with partial weight bearing.
A
cane
or other device
will be used for this.
Therapy in
the pool may also be advised. Your doctor may
also
offer
physical therapy to help you
strengthen your muscles.
Gentle massage, heat, and transcutaneous electrical stimulation (TENS) may also be used to relieve pain.
Depending upon your underlying condition, your doctor may prescribe:
-
Daily
calcium
and
vitamin D
for bone health
-
A hormone medication like
calcitonin
to increase bone mass
-
A narcotic or
acetaminophen
(Tylenol) to relieve pain
In some cases your doctor may
choose
to immobilize
your injury.
A
corset or
brace
can
provide
support and
relief.
Prevention
To help reduce your chance of getting sacral stress fractures, take the following steps:
- Carefully plan your exercise routine. Make gradual changes in intensity.
- Practice good nutrition for bone health. This includes adequate amounts of calcium and vitamin D.
-
Use proper equipment when exercising including
supportive footwear.
- Talk to your doctor about how to prevent osteoporosis.
Hosey RG,
et al. Evaluation and Management of Stress Fractures of the Pelvis and Sacrum.
Orthopedics. 2008; 31:383.
Lin JT, Lane JM. Sacral stress fractures.
Journal of Women’s Health. 2003;12(9):879-888.
Low back pain fact sheet. National Institute of Neurological Disorders and Stroke website. Available at:
http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm. Accessed October 23, 2008.
Micheli LJ, Curtis C. Stress Fractures in the Spine and Sacrum.
Clinics in Sports Medicine. Jan 2006;25(1).
Spondylolysis and spondylolisthesis. American Academy of Orthopaedic Surgeons website. Available at:
http://orthoinfo.aaos.org/topic.cfm?topic=A00053. Accessed October 23, 2008.
Stress fractures. MayoClinic website. Available at:
http://www.mayoclinic.com/print/stress-fractures/DS00556/DSECTION=all&METHOD=print. Accessed October 23, 2008.
Zaman FM. Sacral stress fractures.
Curr Sports Med Rep. 2006;5(1):37-43.
Last reviewed September 2012 by John C. Keel, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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